Re: [ozmidwifery] MORE ACTIVE MANGAEMENT

[Jenny Cameron]

Hello Marilyn
I am surprised that litigation- mad America sanctioned midwives performing
MROP. If the placenta is difficult to remove manual removal may result in
death from shock as well as haemorrhage.
Jenny
Jennifer Cameron FRCNA FACM
ProMid
Professional Midwifery Education  Service
0419 528 717
----- Original Message ----- 
From: "Marilyn Kleidon" <[EMAIL PROTECTED]>
To: <ozmidwifery@acegraphics.com.au>
Sent: Tuesday, March 01, 2005 2:24 PM
Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT


Jenny:
I know that  what you say is Australian practice and if i were attending
homebirths here I would always transfer rather than do a manual removal of
either a partially detached placenta or retained products however it
wasn't
considered outside of a midwife's scope of practice in the USA where I
practised (california and washington state), in fact  it was required by
state law that i be capable of carrying out this procedure. The exact
procedure is detailed in Varney's Midwifery third edition, p. 843, Chap
68.
Most certaily considered part of the midwife's scope of practice. I would
suggest that any birth attendant practicing in an out of hospital  setting
should at least know what to do and have practiced the procedure just in
case which is what Sue was saying is her situation. I have never actually
done the procedure myself but was knowledgeable of it, tested on it with
simulation (as it is NOT something you practice on someone) and aware when
it is necessary. Definetely quite different than removing a placenta
trapped
in the vaginal vault, the os, or lower segment.
marilyn
----- Original Message ----- 
From: "Jenny Cameron" <[EMAIL PROTECTED]>
To: <ozmidwifery@acegraphics.com.au>
Sent: Sunday, February 27, 2005 9:00 PM
Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT


Manual removal of a separated placenta is different to manual removal of
a
placenta still attached to the uterine wall. Removing a separated
placenta
from the os or lower segment is not difficult but it is uncomfortable for
the woman. Manually detaching a placenta from the uterine wall is
barbaric
and traumatic and should not be carried out unless under adequate
anaesthetic and fluid replacement. Granted a partially separated placenta
is
a high risk situation as bleeding will continue until separation.
Although
this is an emergency we would better to summon help and use bi-manual
compression to slow/stop the bleeding until assistance arrives. If you
are
performing true manual removal of the placenta and membranes (ie
partially
separated placenta ) as a midwife you are practising outside your scope
of
practice.
Jenny
Jennifer Cameron FRCNA FACM
ProMid
Professional Midwifery Education  Service
0419 528 717
----- Original Message ----- 
From: "Sue Cookson" <[EMAIL PROTECTED]>
To: <ozmidwifery@acegraphics.com.au>
Sent: Monday, February 28, 2005 7:31 AM
Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT

> Hi Sue,
> I was taught that if doing a manual removal would effectively save the
> woman's life, then that was the best option. Obviously a risk vs
> benefit
> type of situation. The doctor I trained with did the occasional manual
> removal at home rather than the time challenging option of
> transferring,
> and always with the woman's cooperation. I work rurally, and sometimes
the
> speed of the bleed and the distance from hospital would equal real
damage
> to the woman. As I said in my posting, I have not had to perform a
manual
> removal, but I can and would if it was a life saving procedure.
>
> I thought the hospital acted very dangerously by delaying many aspects
of
> their management of the PPH I witnessed last year, and that all up, a
> manual removal there and then would have been the quickest and safest
> option. Instead the woman went on to lose much more blood over another
40
> minutes or so until in theatre, and then faced the choice of
transfusion.
> I found that management very scary.
>
> I have witnessed one manual removal in a hospital on the delivery bed
> after the cord tugging GP/Obs broke the cord whilst trying to extract
the
> placenta (after a forceps delivery). He simply went straight in after
the
> placenta and delivered it quite quickly. The woman was not too
perturbed!!
> (and hadn't had any drugs either).
>
> So I guess it's a matter of training, attitude, access and
> appropriateness - all to be assessed in a very short time frame if a
real
> bleed is occurring.
>
> Sue
>
>
>> I am a bit confused here - can you please explain how you do manual
>> removal in the home situation? Surely this is too dangerous a
>> procedure
>> to do at home? Thanks Sue
>>
>>     ----- Original Message -----
>>     *From:* Marilyn Kleidon <mailto:[EMAIL PROTECTED]>
>>     *To:* ozmidwifery@acegraphics.com.au
>>     <mailto:ozmidwifery@acegraphics.com.au>
>>     *Sent:* Monday, February 28, 2005 1:34 PM
>>     *Subject:* Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
>>
>>     Totally agree Sue. I was taught manual removal too and exactly the
>>     same re
>>     when to apply gentle but firm CCT. However, for a manual removal
>>     at home you
>>     do need maternal cooperation and did have one incidence in Seattle
>>     where we
>>     had to transfer for prolonged moderate/heavy blood loss that just
>>     would not
>>     settle and uterus that kept getting boggy. Para 3 with several
>>     years between
>>     each of the births, third birth being precipitous, placenta
>>     delivered easily
>>     (dirty duncan if you know what I mean) physiologically but
>>     bleeding would
>>     not subside and mum kept soaking a pad in an hour, could not stand
>>     a hand
>>     going past the introitus and was happy to go to the hospital.
>>     Estimated
>>     blood loss was 1600mL including theatre, a pin head size piece of
>>     membrane
>>     was all they could find. Mum declined transfusion and was home the
>>     next day
>>     tired but happy.
>>
>>     marilyn
>>
>
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